Whatever happened to nursing? The final days of my wife, Betty

Michael Church read last week's Patients Association report on poor hospital care with bitter recognition. It brought back terrible memories, and here he delivers a searing indictment of the NHS from painful experience

Michael Church
Sunday 13 November 2011 01:00 GMT
Michael and Betty on holiday in Lisbon in 1994. She died after an unhappy stay at University College Hospital, London two years ago
Michael and Betty on holiday in Lisbon in 1994. She died after an unhappy stay at University College Hospital, London two years ago (Michael Church)

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The Patients Association has issued a damning report on nursing care in NHS hospitals, claiming that patients' needs for the most basic things – pain relief, food and water, toilet help – are in some places being systematically ignored. This is just the latest in a series of critical reports from watchdog bodies such as the Care Quality Commission and charities such as Age UK. And it's rung a bell which has tolled in my brain ever since I became embroiled in nursing matters at University College Hospital, London two years ago.

I thought I knew what to expect when my wife Betty was admitted, but my notion of life as an NHS in-patient was coloured by my experience way back in 1966, when I spent two weeks in the old Royal Free. There were 20 of us in our draughty Victorian ward, over which an Italian joker presided. He and his team of nurses created an atmosphere reminiscent of a high-school dormitory, but nothing escaped his caring and all-seeing eye, and an easy camaraderie prevailed between the patients and the staff, who made a point of getting to know their needs.

In the autumn of 2009, Betty, who had suffered a devastating stroke five years previously, was felled by another which removed her capacity to walk, so she was rushed into hospital. Since UCH had been showered with government money, we anticipated top-quality care. And in the "acute" ward where they initially put her, she got it. But when they'd done all the tests and concluded that partial rehabilitation was the best that could be hoped for, they moved her to an over-sixties ward where people were put when medical science could no longer cure them. Here she would receive care, prior to her move to a residential rehab unit.

If that was the theory, the reality fell far short. It became immediately clear that care was at best intermittent: if you managed to find a nurse – not always easy – there was no guarantee that they would be either able or willing to help you. I got used to running errands for those of Betty's neighbours without a relative or friend on hand, trying to get somebody – anybody – to bring them a commode, or change their soiled nightdress. A 90-minute wait for such assistance was not unusual. Opposite was a grand old lady whose dementia prevented her feeding herself, but every day her food was put in front of her and – unless some passing visitor lent a hand – was routinely taken away cold an hour later. Feeding her wasn't the job of the food-trolley man, and it didn't seem to be the nurses' job either.

Indeed, we never knew what any given nurse's job was, or where their duties ended and those of the rag-tag auxiliaries began. All we knew was that there weren't nearly enough nurses, and almost no continuity, so that we had repeatedly to explain Betty's needs from scratch. With a few gloriously shining exceptions, our nurses were either truculent, or bossy, or downright incompetent.

A further stroke removed Betty's ability to swallow, and she was put on a drip. I enlisted a team of friends and private carers to provide the continuous day-long care which she now needed and which the hospital demonstrably could not provide. And it was one of these carers who noticed that the drip had come out of Betty's vein after the evening nurse had "checked" her to ensure she was set up for the night: without those sharp eyes, Betty would have dehydrated until morning.

After having left her in good spirits one Saturday night – she always bounced back and made the best of things – I came in at 8.30am the next day to find that someone had got her out of bed and into a chair, with her tray of breakfast in her lap. But her speech was slurred, her movements lethargic, and there was food clogging her mouth... another stroke. When I grabbed a nurse and pointed this out, the reply was a weary shrug: OK, she would call for a doctor, but this was Sunday and there was only one on duty for the entire hospital, so it might take time. It took four hours. Illness may be a 24/7 thing, but medical care was unalterably 12/5. Later that day, when Betty indicated she was cold, even something as simple as an extra blanket could not be produced and I had to get a friend to bring one in from home.

With Betty's natural optimism exhausted by anxiety and distress, it became imperative to get her out of this place. And though she only lived for seven further days after her return home, her escape from the dysfunctional world of UCH felt to her – and still does to me – like an absolute triumph.

So much had been wrong in this "flagship" hospital, from the blocked ward sinks and out-of-order televisions and drinks machines (all "out-sourced") to the chronic lack of communication between departments; from the invisibility of consultants to the manic turnover of junior doctors. The ward's (rotating) sisters were always hunched over their computer in a corner, implicitly discouraging enquiries of any sort. Nobody was in charge. Why have the consultants – all of whom must know this – never spoken out? Anecdotal evidence from neighbours indicates that, two years on, things are no better. And if UCH is one of Britain's "best" hospitals, God help the others.

But nursing is the key, and the signs are – quite apart from rising staff shortages – that it's going to become even worse. The Department of Health plans to abolish the practical diploma which nurses have traditionally taken: it plans to make nursing an all-graduate profession. Meanwhile state enrolled nurses – the junior ranks who used to keep the wards going – have been replaced by armies of untrained auxiliaries. It's a safe bet that the new graduate nurses will regard the real mucky business of patient care as beneath their dignity.

What sick people need above all is empathy and human kindness. Those who possess these qualities make the best nurses in the world; those who don't, simply shouldn't work in hospitals. Empathy should be both prized and financially rewarded, and psychological screening should be used to sort the wheat from the chaff – among nurses as it is for hospital administrators. Without human kindness, we are lost.

Michael Church is a music critic for 'The Independent' (m.church@btinternet.com)

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